SECTION 7Depression

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Depression

► The impact of stroke on the survivor’s feelings and social life

► Understanding post-stroke depression► Signs of post-stroke depression

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Depression

Stroke can affect:► the survivor’s emotions and self-image. ► relationships with family, friends, and others.

Many people who survive a stroke feel fear, anxiety, frustration, anger, sadness, and grief for their physical and cognitive losses. These feelings are normal

► Some may feel they are on an emotional roller coaster.

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Depression

Some emotional disturbances and personality changes are also caused by the physical effects of brain damage.

These feelings may or may not be depression.

It is important for a doctor to decide if the person is depressed or just having a normal reaction to the effects of a stroke.

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Depression

Survivors who cannot speak can feel very isolated and frustrated by their inability to communicate.

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After a stroke: First reactionsShock - Why did this happen to me? How could

this have happened?► They may:

wonder if they will survive worry about having another stroke be unsure what life will be like be concerned how their family will cope

wonder if they will work again

Anxiety is a normal reaction to the changes

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After a stroke: Later reactionsAs time passes the stroke survivor may have these

feelings:• Frustration about:

o Physical limitso Memory losso Trouble speaking

► Fatigue from:o Effects of strokeo Increased effort needed to do routine tasks

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After a stroke: Later reactions

► Not seeming to care (lethargy) about social contact:

o Being embarrassed about physical changeso Having trouble speaking or being understood

► Sadness about:o Loss of abilitieso How they feel about themselveso How they believe others feel about them

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How you can helpYou can help stroke survivors find value in their lives:► Be supportive and encourage the survivor.► Find out how the survivor is feeling. Look for signs of

depression or other emotions that affect the survivor in a negative way.

► Share your findings with the team.► Allow the survivor to do what they can. Provide support if

the task becomes too hard, frustrating or tiring.► Offer positive feedback► Gently offer information that helps the survivor be

independent

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Key point

Less than half of survivors with post-stroke depression are identified.

Learn to recognize the signs of depression and get help fast.

If a survivor is thinking about death, dying, or ending their life, report this information to your supervisor immediately.

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Post –stroke depression

It is normal to feel sadness and a sense of loss after a stroke. But sometimes a stroke survivor can develop a true clinical depression.

Depression is a sense of hopelessness. It disrupts a person’s ability to function.

It is common among stroke patients.

Depression can be treated. And the faster it is treated, the better.

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Post –stroke depression

Post-stroke depression can occur right after stroke. Most often, it develops within 3 months.

Depression can also occur up to 2 years after stroke.

Depression gets in the way of physical and mental recovery

Depression in a stroke survivor can also affect the health of caregivers at home.

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Post-stroke depression

Is it “the blues” or clinical depression?

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Signs of post-stroke depression

Physical signso Trouble sleepingo Weight losso Decreased energyo Easily fatigued

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Signs of post-stroke depression

Attitudeso Not caring about anythingo Loss of interest in things that were

previously enjoyedo Negativity: everything is gloomyo Self-focus: me, myself and Io Difficulty connecting to others

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Signs of post-stroke depression

Emotionso Feelings of hopelessness and

worthlessnesso Sadness and anxiety or nervousnesso Thoughts of death and suicideo Difficulty coping, easily overwhelmed

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Signs of post-stroke depression

Mental functiono Difficulty concentratingo Problems making decisionso Confused, feeling of living in a fogo Short-term memory problems

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How you can help

Know the survivor► Get to know the survivors you look after. It can

help you identify mood changes► Take the time to listen► Talk to family and friends► Have team discussions. Learn about the

survivors you look after from other staff

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How you can help

Communicate with the survivor► Depression is a medical illness. Always

communicate with caring and hope. Be accepting – not judgmental

► Learn how to communicate with survivors who have communication problems

► Ask survivors how they are feeling. If they are feeling pain, make sure they get treatment to relieve the pain

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How you can help

Observe the survivor

Look for:► New symptoms► Sudden changes in behaviour or personality► Signs of depression lasting more than 2 weeks► Sleeping or napping more than usual► No longer attending favourite social activities.

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How you can help

Support the survivor► Find out what resources are available► Let survivors know about activities and

assistance► Help them plan and structure the day. Routine

can help people adjust

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How you can help

Encourage the survivor to do things► Help them get to activities they enjoy► Spend time with them in activities such as

playing cards or board games► Find activities that make them feel better, such

as listening to music, watching videos, or reading

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How you can help

Encourage emotional expression► Allow stroke survivors to express their grief and

sadness about what they have lost► Always give them hope that things can improve► Share what you learn with the rest of the team

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Test yourselfAre these statements true or false? True False

1. Post-stroke depression is often not identified.

2. Depressed people can just “snap out of it”.

3. Asking a depressed person about suicidal thoughts is dangerous.

4. A person who has had a stroke is at higher risk for depression.

5. A stroke survivor who is depressed may experience physical, emotional, and cognitive changes.

6. “The blues” and clinical depression are the same thing.

7. Depression is a treatable medical illness.

8. I can help identify depression in a survivor by really listening to and knowing them.

9. When I see the signs and symptoms of depression in a survivor I should keep it to myself.

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Answers

1. True

2. False

3. False

4. True

5. True

6. False

7. True

8. True

9. False

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